ESWL in children remains controversial and any treatment decisionreflects a balance between its benefits of non-invasiveness andeffectiveness and its adverse effects that may be significant in pediatricpatients. Our prospective study was conducted to assess the efficacy of ESWL asan emerging modality in treatment of pediatric renal calculi. Severalfactors interact to predict the outcome after ESWL. These range fromthe site, size and type of stone, to the operator’s experience, themachine’s design and condition and the patient selection. All children younger than 15 years with radio-opaque renal stones weretreated by ESWL as a first line treatment or as combined therapy.Pretreatment KUB and IVP and Post treatment ultrasonography andKUB films were used to follow up the clearance of fragments. Overall stone free rate was 83.7%. 10.8% of the patients had clinicallyinsignificant fragments and were instructed to follow up for thepossibility of stone re-growth, the presence of microscopic hematuriaand urinary tract infection. ESWL was unsuccessful in 5.4% of ourpatients and another treatment modality was chosen for them.Complications were encountered in 16.5% of our patients. ESWL is recommended as the primary treatment of choice for pediatricrenal stones < 20mms in all caliceal locations. ESWL is highly effectivefor treatment of larger stone sizes however; preliminary ESWL stentingand long term follow up of kidney functions should be analyzed inadditional studies.